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Women's Health > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Abortion: Types, S/Sx

A

Elective or spontaneous
No fetal viability before 20weeks

S/sx:

Uterine Cramping
Vaginal Bleeding - bright red
Pelvic Pressure
Backache

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2
Q

Ecotopic Pregnancy: What it is, S/Sx, Treatment

A

Fertilized ovum outside uterus in fallopian tube

S/Sx:
UNILATERAL, sharp abdominal pain
Normal pregnancy symptoms
positive pregnancy test

If suspected you can perform gentile uterine palpitation

Treatment:
NPO if surgery (sometimes sent home on methotrexate)
VS
Monitor for signs of bleeding, including Cullen Sign
Type and Crossmatch blood

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3
Q

Molar Pregnancy

A

Degenerative placenta, fertilized egg without embryo but incorrect chromosomes

Characterized by grape-like clusters

S/Sx:
Preeclampsia prior to 20 weeks
NO FHT or skeleton
hCG continues to rise when it should decline
Abnormal uterine bleeding
Uterus larger than dates
Anemia from blood loss
Excessive vomiting
Abdominal cramping

Treatment:
- Prep for D&C
- Monitor hCG levels for 1-year: monthly for first 6-months then every 2 months for 6-months
-No pregnancy for 12-months as pregnancy can mask symptoms of chorioncarcinoma
- Possible prophylactic chemo

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4
Q

Placenta Previa: S/Sx, Management

A

Placenta is implanted in lower uterus instead of fundus due to uterine scarring, surgery or fibroid tumor

Usually occurs in 3rd trimester

S/Sx:
PAINLESS
bright red bleeding
uterus is soft
Possible signs of shock
Abnormal FHR

Treatment

Best rest - sent home after 48-hours if no bleeding
<36 weeks may be monitored in hospital
>36 weeks may deliver

Interventions
side-lying position
NO leopold or vaginal/rectal exams
monitor VS every 15 minutes
IV fluids - 2 large bore IVs
Use external monitor for contractions and FHR
Type Cross match blood for delivery

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5
Q

Placenta Abruption: S/Sx, Treatmetn

A

Premature separation of placenta from uterine wall
Medical emergency late in 3rd trimester

Risk increased with HTN, high gravidity, trauma, short umbilical cord or cocaine

S/Sx

Rigid, board-like abdomen
Pain WITH epidural

Medical Management:

Best Rest
External monitoring only
Labs: CBC, PT, aPTT, INR

Nursing Interventions:

VS q15
Side-lying position
2 large bore IVs
Prep for c-section
Monitor blood loss, save all pads, linens
Monitor for DIC

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6
Q

Signs of DIC

A

bleeding gums or nose
reduced lab values for platelets and prothrombin
Bleeding from IV sites
Ecchymosis

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7
Q

Gestational Diabetes: What’s happening, risks?

A

Hormonal changes increase maternal insulin resistance to ensure baby has enough glucose

Insulin resistance due to placental hormones (insulinase and cortisol)

Moms are more prone to preeclampsia, hemorrhage, infection, hydroaminos and macofetus

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8
Q

Glucose Tolerance Test

A

Performed at 24-26 weeks
No need for fasting

1-hr:
- 50g glucose given and blood sugar checked at 1hr, if greater than 140 then 3-hr test performed

3hr:
- 100g glucose given and if 2 or more values are met or exceeded then this indicates positive

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9
Q

Insulin Needs by Trimester

A

First Trimester: Decreased
Second/Third: Increased due to placental hormones

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10
Q

GDM: First Trimester Risks

A

Uncontrolled glucose is a teratogen and may result in cardiac malformation

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11
Q

Macroscopic Fetus

A

> 4000g

May cause prolonged 2nd labor stage, head injury or shoulder dystocia

If C-section, then baby may have respiratory distress due to absence of vaginal squeeze

Baby may experience hypoglycemia

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12
Q

Respiratory Distress in GDM

A

Caused by decreased surfactant

Increased risk ventilation or supplemental oxygen

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13
Q

Neonatal Hyperproliferation of Pancreas

A

Enlarged pancreas due to high maternal glucose which causes increased insulin needs in fetus, but when umbilical cord is cut then no constant source of glucose but pancreas continues to put out high levels of insulin

Resolves in 4hrs, but if baby is >5000g then it can take a week

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14
Q

Pregnancy Testing for GDM

A

Ultrasound, nonstress tests and biophysical profiles

NST tests in 32-weeks and 2x weekly

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15
Q

In GDM, what happens in 3rd stage of labor to mom?

A

Insulin requirements drop substantially in first 24-hours, recommended to discontinue long acting insulin before delivery.

Mom recommended to breast feed for better glucose control

Hospital Care:

5% glucose infusion
Monitor ketones
monitor hemorrhage

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16
Q

Fetal Lung Maturity

A

Based on LS - lecithin:sphingomyelin ratio

Accounts for AFV changes

Considered mature if ratio >2.2 or if PG (phosphatidyglycerol) is present in surfactant past 36 weeks

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17
Q

Hyperemesis in pregnancy: S/Sx, Medication, Assessment, Nutrition

A

S/Sx:

Weight loss
dehydration
dry mucus membrane
decreased bp
increase pr
poor skin turgor

Medication: diclegis, compazine, zofran, phenergan

Assessment: ask about frequency, duration, and severity

May require TPN

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18
Q

When is nausea abnormal in pregnancy?

A

If it is excessive or prolonged vomiting with weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria

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19
Q

Hypothyroid

A

Increased risk of infertility and miscarriage

S/Sx:
cold intolerance
lethargy
decreased exercise tolerance
weight gain

Medication: levothyroxine (synthroid)

20
Q

Hyperthyroid

A

S/Sx:

Heat intolerance
diaphoresis
fatigue
anxiety
emotional instability
tachycardia >100bpm

21
Q

Chronic HTN

A

HTN before pregnancy of prior to 20 weeks

22
Q

Gestational HTN

A

HTN after 20 weeks w/o systemic features

23
Q

Eclampsia: S/Sx, treatmetn

A

Pregnancy HTN w/ seizures

S/Sx

Persistent headache, blurred vision, epigastric/RUQ pain, AMS, SEIZURE

Medication: MgSO4 before and 24-hours post if no signs of toxicity;

Treatment:
Side- lying position
oxygen

24
Q

MgSO4 Toxicity

A

Therapeutic Range: 4-7 mg/dL
MgSO4 also hs increase risk of post partum hemorrhage has it relaxes muscles and uterus not able to contract

S/Sx:

ABSENT DTR
Decrease RR
Diaphoresis/flushing
Warmth
EKG Changes
Decreased UOP but increase in mag level

Antidote: calcium gluconate

25
Q

Preeclampsia: S/Sx, medication, complications

A

HTN after 20-weeks gestation with no history of HTN

S/Sx: (acronym = pre)

Proteinuria
Rise in BP (>140/90 on 2 occasions) or >160/90 on shorter occasions
Edema
Rapid weight gain >2lbs/week
Decrease UOP
Hyperrefelxia 2+ Clonus

Medication:

Labetaol
Hydrazine hydrochloride

Complications: eclapsia, HELLP syndrome, DIC

26
Q

HELLP Syndrome

A

Life threatening complication of preeclampsia

S/Sx (HELLP)

Hemolysis
Elevated Liver enzymes
Low Platelet count
Malaise
epigastric/RUQ pain
N/V
Normotensive w/o proteinuria

Treatment: MgSO4

27
Q

First Trimester Ultrasound

A

Ask mom to drink 3-4 glasses of water and to not urinate

of fetuses
presence of fetal cardiac movement/rhythm
uterine abnormalities
gestational age

28
Q

Second Trimester Ultrasound

A

Fetal viability and gestational age
Size-date discrepancies
AFV
Placental location and maturity
Uterine abnormalities

29
Q

Biophysical Profile

A

Assessment of fetal well-being based on 5 factors

1) fetal breathing movement
2) Gross body movement
3) fetal tone
4) Reactivity of FHR
5) AFV

Score of 2 or 0 can be assigned, fetal well-being 8-10 is healthy

30
Q

Chorionic Villi Sampling

A

Performed at 10-12 weeks gestation

Evaluates DNA, bleeding, infection or miscarriage risk

31
Q

Amniocentesis: What is it, when is it performed, what does it determine, complications

A

Performed at 20 weeks

Anatomy or DNA for high-risk moms

Determines:
karotype
biochemical analysis
AFV
Fetal lung maturity
Fetal well-being

Complications: infection, miscarriage, bleeding

32
Q

Karotype

A

down syndrome/trisomy 21
Sex chromatin disorders

33
Q

Biochemical analysis

A

Tay Sachs

34
Q

AFV: Increased or decreased

A

Increased - neural tube defect
Decreased - trisomy 21

35
Q

What can meconium in an amniocentesis indicate?

A

fetal distress

36
Q

PUBS

A

Percutaneous umbilical blood sampling

Dx blood disorders, anemia, sepsis, genetic, Rh

Complications: bleeding, infection, miscarriage

37
Q

Fetal heart Echo

A

Fetal heart sonogram for structural abnormalaties

38
Q

Fetal Movement

A

Evaluate fetal oxygenation

39
Q

Fetal Kick Counts

A

Fetal movement evaluates fetal oxygenation

Emergency: No kick counts of <10 in 12 hours

40
Q

Non-Stress Test

A

Evaluates fetal oxygenation

Reactive=normal

If nonreactive, then will need biophysical profile (in utero) and apgar (out of utero)

41
Q

In-utero biophysical profile

A

Reactive NST
Fetal Breathing
Tone - should be flexed
Fetal Movement
Amniotic Fluid - is it enough for gestation?

42
Q

Apgar

A

Scored 0 to 10, with 7 to 10 being okay/supportive care

Heart rate >100
Cry - should be vigorous
Tone - should be flexed
Reflex irritability
Color - should be acrocyanosis or pink
Respiratory effort

43
Q

Contraction Stress Test

A

Evaluates fetal oxygenation and ability to tolerate contractions w/o placental insufficiency

negative contraction test is desired
positive indicates late DHR decelerations

44
Q

Rh Incompatibility

A

AKA isoimmunization

When mom is Rh- and baby is Rh+, it has inherited this gene from the Dad, mom will create antibodies against the fetus, typically the first pregnancy is not affected, but antibodies grow with future pregnancies

If not treated, then fetus can become anemic or jaundiced with immature RBC production

No impact if mom is + and baby is -

Complication: Hydrops Fetalis

45
Q

Hydrops Fetalis

A

Untreated Rh incompatibility

Risk for anemia, cardiac decompensation, cardiomegaly or hapatospleomegaly

Hypoxia occurs due to severe anemia
Ascites occurs due to fluid mobilization and fluid develops in periotoneal cavity

46
Q

How do we test for Rh incompatibility?

A

Indirect Coombs - detects antibodies in Mom against Rh - fetus

Direct Coombs - detects antibodies against Rh+, performed with PUBS

Women's Health (6 decks)

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